Provider Demographics
NPI:1811082233
Name:MACNAB, DENNIS KEITH (DMD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:KEITH
Last Name:MACNAB
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 E 12TH STREET
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-3212
Mailing Address - Country:US
Mailing Address - Phone:541-296-2581
Mailing Address - Fax:541-296-8655
Practice Address - Street 1:1629 E 12TH STREET
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3212
Practice Address - Country:US
Practice Address - Phone:541-296-2581
Practice Address - Fax:541-296-8655
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD62861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice